Some Things Really Are Less Affordable Under Obamacare

REUTERS/ Jason Reed
In a lot of ways, for a lot of Americans, the Affordable Care Act, aka Obamacare, has delivered precisely what its official moniker suggests: affordable health insurance.

Speaking on a purely personal level, the plans I could buy post-Obamacare carried monthly price-tags ranging from $350 to $700 - a far cry from the solitary plan available to me before, priced at $1,785 a month.

And yet, the cost of staying healthy isn't always picked up by your health insurance company.

Under Obamacare, Americans may no longer have to choose between bankruptcy and getting medical treatment for life-threatening illnesses. But the burdensome costs of the routine stuff could become still weightier.

Family members might once have been covered as part of a benefits package but now were covered at additional cost; employees were told they'd be picking up part of the cost of some of the plans (especially "extra" benefits, like dental or vision plans). As the years have passed, benefits themselves have become leaner, as both employers and insurers have sought to cut expenses.

Just ask Rita Cheng, a financial advisor at Blue Ocean Global Wealth in Bethesda, Maryland. She helps her clients cope with their rising costs - including medical expenses - and deals with the financial impact of her 15-year-old son's chronic asthma.

Advertisement

"The co-payment for the inhaler he needs for his maintenance - to prevent a severe attack - used to cost me $7," she says. "Then it went to $30. Then $60. Now it's $100, every month." In other words, she is now paying more than half the cost of the medication, with her insurance picking up the remaining $81.

"It's not as if you have a choice about whether or not to use an asthma inhaler," she points out.

Ironically, Obamacare may only have made matters worse for the cost of day-to-day healthcare including vision and dental plans.

People like Cheng who know that they're going to be forking over a lot of money for stuff that isn't covered by their insurance plan - co-payments, deductibles, or treatments after you've reached your annual maximum - can use pretax dollars from their paychecks to set up either a health savings account (HSA) or flexible spending account (FSA).

(Here's the difference in a nutshell: employers have the option of offering an FSA; if they don't and you're enrolled in a high-deductible health plan, you can set up your own HSA.)

Advertisement

Pre-Obamacare, there wasn't any official maximum limit to FSAs. A number of employers set the contribution as high as $5,000.

So if you knew you'd be forking over a lot for your teenager's braces, your husband's dental work and your own arthritis medications, and that changes to your health plan meant you'd be shouldering more of the burden for routine office visits to doctors, you could set aside $3,000 or more.

"With the arrival of Obamacare, I am seeing more complexity, including people finding that their longtime physicians are now out of network and have to be paid out of pocket," Cheng notes.

It all adds up. For me, that means discovering that in my new network, there isn't a single neurologist in my new network who is accepting new patients.

Advertisement

I've now found a great out-of-network doctor, but I'll pay $2,000 a year on top of my new, affordable, Obamacare healthcare premiums to consult him. And let's not even talk about the fact that the typical dental plan's benefits max out at about $2,500: if you need two root canals, you're done for the year (and you've probably still paid $1,200 out of your own pocket).

Heidi Leighton, a Maine office worker, already rations the frequency with which she takes Trexemet, the medication she uses to control her migraines. "It costs $5 a pill, and there's no generic yet," she says.

She frets about having to take a day off work to travel two hours each way to Bangor in order to have medically-necessary bloodwork at an in-network hospital. (She could have it done locally, and not lose a day's wages - but then she'd have to pay $100 out of pocket.)

But it's the insurance company's policy on orthotics that really annoys her.

"As a child I had foot surgery to separate small bones that had fused together and now I need custom orthotics" in order to be able to stand without pain and remain physically active, even mobile. That's about $120 a year - and the insurance company won't pay a dime, even though without them Leighton risks ending up on disability.

Advertisement

"Any one of these costs on its own is no big deal, but if you add them up, it's bad news, even though it's somehow it's never quite enough to qualify as a deduction against our income taxes."

For many Americans, it's going to feel as if new costs are sneaking up on us as a result of Obamacare in part, says Eleanor Blayney, consumer advocate for the CFP Board. It mandates that health insurance policies cover things that once weren't required, like alcohol counseling or treatment for obesity. Women may end up getting a greater array of obstetrical and gynecological care and procedures covered, while children up to the age of 26 are covered.

"So as the costs of those requirements are priced in, other cuts may show up," says Blayney.

Employers may decide not to cover healthcare for spouses; they may not offer dental policies or vision care, or may no longer subsidize those plans. UPS has already made headlines because of its decision to yank healthcare coverage for its employees' spouses.